The government's latest solution to managing its self-induced demand on general practice is to create a posse of American-style physician associates. But our universally accessible UK general practice is vastly different to the insurance/Medicaid based US primary care physician model. In the UK we train GPs to be expert generalists to a registered population; preventing illness; dealing with the social and psychological components of ill-health; holding health risk; sorting undifferentiated symptoms; diagnosing and managing complex multi-morbidity; managing uncertainty; and delivering continuity of relationship as a key part of care. Through our therapeutic relationships with patients, UK GPs are themselves the treatment as well as the prescribers and gatekeepers.
Contrast this with US primary care physicians who are essentially internal physicians following a highly medical model similar to that practiced in our hospitals and outpatient clinics. They specialise in disease, and we specialise in dis-ease. I envy them their 30 plus minutes of consultation time, but I do not envy their pre-packaged, protocol-driven, ready-sifted, ready 'clerked', sterile processing of patients. It is an approach which turns patients into bit-part packages to be over-treated and pandered to.
Why have physician associates when we already have practice nurses and advanced nurse practitioners - a feature that doesn't appear on the US primary care physician landscape? Creating yet another new position, is a distraction which we can ill-afford, unless of course the intention is to drive down clinician costs and wages, similar to the approach adopted with teaching assistants or police community support officers.
For physician associates there is at present no professional regulation, their membership of a register is voluntary. But guess what, this is being taken over by that bastion of generalism the Royal College of Physicians, which is setting up a faculty incorporating the UK Association of Physicians Associates (and is planning to accredit courses and hold the register). Bodes well for general practice! But never mind that. We can all be reassured by the plethora of untried new courses springing up, funded by Health Education England grants, with the number of centres offering courses rising from two to eight this year alone . And these budding physician associates are not even necessarily placed in recognised GP training practices for the GP aspect of clinical training.
So big caveat emptor on that. And some concerns: What the indemnity costs and who will pay them? Physician associates need space and longer appointments; they cannot deal with complexity so that leaves so-called minor illnesses or some long-term conditions that somehow do not require complex management - which are they then? And to crown it all, there is at present no study or evidence to show whether employing a physician associate in a practice actually saves GPs any work!
I do not consider myself, and have never been considered by my practices or patients, to be change-resistant. In fact I have championed change, none the least by pioneering advanced nurse practitioners in UK general practice. But this initiative is a band-aid at best, and not the solution. That lies with government being honest with patients about demand and what the NHS is for, and increasing the supply of GPs and nurses by sufficient numbers, delivered by strong motivational incentives to enter the service, to remain in the service, and to return.
This article is the unabridged version of a piece which originally appeared on Pulse Today, on 29/05/2015.Suggest a correction